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Updated: Jul 5, 2026
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Hypotension in preterm infants
1Neonatal Unit, Liverpool Womens Hospital, Crown Street, Liverpool, United Kingdom L8 7SS. hafisibrahim@hotmail.com
Insights
Hypotension in preterm infants is multifactorial, often linked to cardiac issues rather than fluid loss. Treatment involves careful fluid management, inotropes like dopamine, and judicious steroid use, considering potential neurological risks.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Pharmacology
Background:
- Hypotension is common in sick preterm neonates.
- It is associated with adverse short- and long-term outcomes.
- Accurate recognition and treatment are crucial.
Purpose of the Study:
- To review the pathophysiology and management of hypotension in preterm infants.
- To guide clinical practice in recognizing and treating this condition.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane databases.
- Hand search of cross-references for relevant articles.
Main Results:
- Hypotension pathophysiology is multifactorial; hypovolemia is a minor factor without overt fluid loss.
- Cardiac dysfunction is a significant factor in some neonates.
- Overzealous fluid administration is linked to adverse outcomes.
Conclusions:
- Hypotension assessment requires evaluating the overall clinical condition.
- Fluid boluses are indicated, followed by inotropes (dopamine preferred) if ineffective.
- Steroids may be used for inotrope-resistant hypotension but require cautious application due to potential neurological risks.
Purpose:
Hypotension is a frequent occurrence in sick preterm neonates. It is important to appropriately recognise and treat hypotension in preterm infants due to the possible association with short and long term adverse outcomes.
Search Strategy:
An extensive search for relevant articles was carried out on PubMed, Embase and Cochrane database of systematic reviews. Cross references were hand searched.
Conclusions:
The pathophysiology hypotension in preterm infants is multifactorial. Hypovolemia plays only a minor role in the absence of overt fluid losses. Cardiac dysfunction seems to be a factor in some neonates. Assessment of hypotension should be based on an overall clinical condition. Overzealous fluid administration seems to be associated with adverse outcomes and should be avoided in the absence of obvious fluid losses. Inotropes should be used if fluid boluses fail to correct hypotension. Dopamine is the most effective inotrope. Dobutamine can be used as add on therapy or as first line if cardiac dysfunction is an obvious cause. Evidence points to hypocortisolism in at least some hypotensive infants. Steroids have been used successfully in inotrope-resistant hypotension in some infants. Steroids should be used judiciously since there have been concerns about adverse neurological outcome in preterm infants who received steroids in the neonatal period.
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